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. 2018 Sep-Oct;20(5):438-441.
doi: 10.4103/aja.aja_76_17.

Transurethral seminal vesiculoscopy for recurrent hemospermia: experience from 419 cases

Rui Chen  1 , Lei Wang  1 , Xia Sheng  1 , Shu-Guang Piao  1 , Xin-Wen Nian  1 , Xin Cheng  1 , Tie Zhou  1 , Hui-Zhen Li  1 , Ya-Wei Liu  2 , Guang-Hua Chen  1 , Chun-Lei Zhang  1 , De-Pei Kong  1 , Guang-An Xiao  1 , Xin Lu  1 , Zhen-Yu Jia  1 , Zhi-Yong Liu  1 , Ying-Hao Sun  1
Affiliations

Transurethral seminal vesiculoscopy for recurrent hemospermia: experience from 419 cases

Rui Chen et al. Asian J Androl. 2018 Sep-Oct.

Abstract

We summarized our experience in transurethral seminal vesiculoscopy (TSV) for recurrent hemospermia by introducing surgical techniques, intraoperative findings, and treatment outcomes. TSV was performed in 419 patients with an initial diagnosis of persistent hemospermia at Shanghai Changhai Hospital (Shanghai, China) from May 2007 to November 2015. TSV was successfully performed in 381 cases (90.9%). Hemospermia was alleviated or disappeared in 324 (85.0%) patients by 3 months after surgery. Common intraoperative manifestations were bleeding, obstruction or stenosis, mucosal lesions, and calculus. Endoscopic presentation of the ejaculatory duct orifice and the verumontanum was categorized into four types, including 8 (1.9%), 32 (7.6%), 341 (81.4%), and 38 (9.1%) cases in Types A, B, C, and D, respectively. TSV is an effective and safe procedure in the management of seminal tract disorders. This study may help other surgeons to become familiar with and improve this procedure. However, further multicentric clinical trials are warranted to validate these findings.

Keywords: endoscopy; hemospermia; transurethral seminal vesiculoscopy.

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Conflict of interest statement

All authors declared no competing interests

Figures

Figure 1
Figure 1
Flowchart of the surgery. For each key step in the surgery, “positive or negative” findings together with further guidance of the next move are listed in the flowchart.
Figure 2
Figure 2
Endoscopic patterns of the orifice of the ejaculatory duct and the surgical path in Type A patients where the orifice of the ejaculatory duct could be observed from the urethra (a); in Type B patients, the ejaculatory duct and the verumontanum were only separated by a thin layer of white membrane-like tissue on the left side (b) or on both sides (c); the membrane-like tissue was not identified at first sight in Type C patients (d), and tentative puncture at the membrane-like tissue were performed in the same patient (e); pressure changes indicated the suspected location for tentative puncture (f) and tentative puncture performed at the suspected location in Type C patients (g); the surgical pathway was established after the tentative puncture in Type C patients (h); the surgical path could not be established in Type D patients (i).
Figure 3
Figure 3
Endoscopic view of the seminal tract. (a) Opening of the verumontanum; (b) orifice of the verumontanum; (c) calculus in the ejaculatory duct; (d) grasping forceps applied for removal of calculus in the ejaculatory duct; (e) normal seminal vesicle; (f) inflammatory lesions in the seminal vesicle.
Figure 4
Figure 4
Pathological review: (a) the verumontanum was split in the middle of the sagittal plane. (b) The histological structure of the ejaculatory duct, the verumontanum, and the membrane between them.
See this image and copyright information in PMC

Comment in

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